1483. Antimicrobial Consumption and Their Resistance in Gram-Negative Bacteria in Pediatric Population
Session: Poster Abstract Session: Antimicrobial Stewardship: Pediatric and OPAT
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • IDWeek2015HN_1004.pdf (496.0 kB)
  • Background: Antimicrobial resistance in gram-negative bacteria is one of the most serious problems in the management of infectious diseases. The correlation between antimicrobial consumption and the rates of antimicrobial resistance in gram-negative bacteria has been documented in adults, but data is limited in the pediatric population.

    Methods: Data was collected on the antimicrobial susceptibility of gram-negative bacteria (Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, and Pseudomonas aeruginosa) isolated from patients at the National Center for Child Health and Development from January 2010 to December 2014. Data on the first available isolate per person was analyzed by year. We also calculated DOT (Days of Therapy) per 1000 patient days, of antibiotics frequently used in our hospital (ampicillin/sulbactam, piperacillin/tazobactam, cefazolin, cefmetazole, cefotaxime, ceftazidime, cefepime, meropenem, gentamicin, and amikacin) by year, as a parameter of the amount of antimicrobial consumption. Then we analyzed the correlation between the DOT and the rate of resistance for the corresponding antibiotic using Spearman’s correlation.

    Results: There were statistically significant correlations between the resistance rate of E. coli and the DOT of cefotaxime (r=0.900, p=0.037) and cefepime (r=0.900, p=0.037), but not meropenem, gentamicin or amikacin, and between the resistance rate of E. cloacae and the DOT of piperacillin/tazobactam (r=0.900, p=0.037), but not cefepime, meropenem, gentamicin or amikacin. In a subset of patient data, we confirmed that the resistance mechanism was primarily ESBLs production for E. coli, and AmpC beta-lactamases production for E. cloacae. However, we were unable to document such correlations for K. pneumoniae or P. aeruginosa.

    Conclusion: The consumption of broad spectrum penicillins and cephalosporins appeared to select for ESBLs producing strains of E. coli and AmpC beta-lactamases producing strains of E. cloacae in the pediatric hospital setting.

    Hidenori Nakagawa, MD1, Miku Hashimoto, MLS2, Satoyo Wakai, MLS2, Makoto Komura, PharmD3 and Isao Miyairi, MD1, (1)Infectious Disease, National Center for Child Health and Development, Tokyo, Japan, (2)Clinical Laboratory Medicine, National Center for Child Health and Development, Tokyo, Japan, (3)Pharmaceutical Department, National Center for Child Health and Development, Tokyo, Japan

    Disclosures:

    H. Nakagawa, None

    M. Hashimoto, None

    S. Wakai, None

    M. Komura, None

    I. Miyairi, Dainippon sumitomo: speaker at a sponsored program , Speaker honorarium
    Kyorin pharmaceuticals: speaker at sponsored lecture , Speaker honorarium
    Astellas: speaker at sponsored lecture , Speaker honorarium
    Teijin pharm: speaker at sponsored lecture , Speaker honorarium
    Daiichi sankyo: speaker at sponsored lecture , Speaker honorarium
    Takeda pharm: speaker at sponsored lecture , Speaker honorarium
    Tanabe mitsubishi: speaker at sponsored lecture , Speaker honorarium
    Janssen: Grant Investigator , Research grant

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